Attitudes and understanding of complementary and alternative medicine in cancer care:An exploratory study of patients’perspectives in Karachi,Pakistan

Objective:To evaluate the prevalence and types of complementary and alternative medicine(CAM)modalities among patients with cancer in Karachi,Pakistan.Methods:This descriptive cross-sectional study was conducted from March 2021 to December 2021.Five hundred patients with cancer were invited to participate in the study.Electronic databases,namely,Google scholar,Publons,EMBASE,PubMed,Chinese National Knowledge Infrastructure Database,and ResearchGate was used for questionnaire designed.The self-administered survey included questions on demographic characteristics,education level,socio-economic conditions and information about CAM therapies,prevalence,effectiveness,and common CAM modalities.Statistical analysis was conducted using SPSS software version 22.Results:Out of the 500 invited patients,433(86.6%)successfully completed and returned the questionnaires.In contrast to patients who were with younger,highly educated,professionally active,higher income,and had advanced cancer,time since diagnosis,type of treatment,cancer types and family history are significantly associated with CAM use.The results showed that 59.8%of the participants were acquainted with complementary and/or alternative medicine and considered safe owing to its natural ingredients.The prevalence of CAM usage among cancer patients was 40.9%and the most widely used CAM modality was herbal medicine(27.7%)and dietary supplements(28.8%).Patients used CAM as a complementary therapy to improve the morphological parameter(28.2%),strengthen the immune system(6.8%),and to decrease the side effects of conventional treatment(18.1%).Most of the respondents get the information regarding CAM therapy from the electronic media(43.2%)and the family members(48%)rather than healthcare personnel.Conclusions:Participants used CAM modalities along with the conventional health care practices.Further multicentre studies should be conducted to provide information regarding the usage of CAM therapies and their eventual benefits in patients with cancer.

Complementary and alternative medicine applications in cancer medicine

Besides conventional medicine,many patients with cancer seek complementary and alternative medicine(CAM)as an additional treatment option.Since the early 1970s,the use of CAM in cancer treatment has expanded worldwide.CAM,as a tempting option,was used by patients with cancer mainly due to easy accessibility.Patients with cancer used CAM to achieve better quality of life or to find a cure.As physicians are mainly unaware of CAM use by patients,doctor-patient communication about CAM use should be brought to a higher level.To identify circumstances in which CAM are preferred,further investigations are needed especially in biologically based therapies.Clinical-based evidence for mind-body therapies have been established,so this type of CAM can be recommended for patients with cancer during chemotherapy.Future studies are necessary to fill the gaps so that CAM users,as well as medical experts,are in position to clearly determine all the benefits and disadvantages of the mentioned therapy.

Thematic Trends in Complementary and Alternative Medicine Applied in Cancer-Related Symptoms

Purpose： The main goal of this study is to discover the scientific evolution of Cancer-Related Symptoms in Complementary and Alternative Medicine research area, analyzing the articles indexed in the Web of Science database from 1980 to 2013.Design/Methodology/Approach： A co-word science mapping analysis is performed under a longitudinal framework（1980 to 2013）. The documental corpus is divided into two subperiods,1980–2008 and 2009–2013. Thus, the performance and impact rates, and conceptual evolution of the research field are shown.Findings： According to the results, the co-word analysis allows us to identify 12 main thematic areas in this emerging research field： anxiety, survivors and palliative care,meditation, treatment, symptoms and cancer types, postmenopause, cancer pain, low back pain, herbal medicine, children, depression and insomnia, inflammation mediators, and lymphedema. The different research lines are identified according to the main thematic areas,centered fundamentally on anxiety and suffering prevention. The scientific community can use this information to identify where the interest is focused and make decisions in different ways.Research limitation： Several limitations can be addressed： 1） some of the Complementary and Alternative Medicine therapies may not have been included; 2） only the documents indexed in Web of Science are analyzed; and 3） the thematic areas detected could change if another dataset was considered.Practical implications： The results obtained in the present study could be considered as an evidence-based framework in which future studies could be built.Originality/value： Currently, there are no studies that show the thematic evolution of this research area.

Clinical Research progress of traditional Chinese medicine in treating esophageal cancer

Esophageal cancer is one of the most common malignant tumors in the world. In recent years, the incidence and mortality of esophageal cancer have increased year by year, which has seriously threatened human health. Surgery, chemotherapy and radiotherapy, as the primary treatments of Western medicine, have achieved specific results in the clinic, but each has its limitations, this is mainly related to their side effects. The diversified treatment methods of traditional Chinese medicine have visible clinical effects, especially in terms of reducing toxicity and increasing efficiency. This present review reviews the research progress of esophageal cancer in terms of traditional Chinese medicine treatment, including the application of Chinese medicine extract, Chinese herbal compound, Chinese patent medicine and TCM external treatment in clinical practice, may provide valuable information for the adjuvant treatment of esophageal cancer with traditional Chinese medicine.

Research progress on regulation of immune microenvironment of breast cancer by Traditional Chinese medicine

Breast cancer is the most common malignant tumor in women,and the current treatment mainly includes surgery,radiotherapy and chemotherapy.With the development of cell biology,molecular biology and immunology,breast cancer has entered the era of immunotherapy.Through multi-level and multi-way regulation of relevant genes and proteins,TCM regulates the immune microenvironment,and has great advantages in inhibiting tumor progression,alleviating surgical complications,improving immune system function,alleviating the damage to the body caused by surgery,radiotherapy and chemotherapy,and reducing the recurrence rate etc,provides ideas for the comprehensive treatment of breast cancer.This paper discusses the understanding of breast cancer in Traditional Chinese medicine,the influence of immune microenvironment on the occurrence and development of breast cancer,and the regulation of immune microenvironment in breast cancer by traditional Chinese medicine,in order to provide theoretical basis for the diagnosis and treatment of breast cancer with traditional Chinese medicine.

Research progress of traditional Chinese medicine monomers in intervening colorectal cancer by regulating MAPK signaling pathway

The incidence rate and mortality rate of colorectal cancer in China are increasing year by year.Finding effective therapeutic strategies and interventions,especially exploring“highly effective and low toxic”drugs to prevent“inflammation-cancer”transformation,treat primary tumors,prevent tumor metastasis and reduce the toxicity and increase efficiency of existing therapies has become a hot topic of domestic and foreign scholars.The advantage of traditional Chinese medicine in the treatment of colorectal cancer is to reduce the postoperative recurrence rate,improve patients’symptoms and the quality of life of“tumor survivors”and prolong the survival time.This paper summarizes the tumor treatment strategies and research prospects of traditional Chinese medicine targeting mitogen activated protein kinase by sorting out the mechanism of traditional Chinese medicine extracts or effective components intervening colorectal cancer by regulating mitogen activated protein kinase signal pathway in tumor cells in recent years.

Policies on Chinese Medicine in China May Have Enlightenments to Complementary and Alternative Medicine in the World

From the event of TU You-you winning the Nobel Prize, this paper briefly reviewed the history of formation and development of policies on Chinese medicine （CM） in China. On the basis of analyzing the causes of policies on CM, it is believed that policies on CM in China may have 4 kinds of enlightenments to the development of complementary and alternative medicine （CAM） in the world. Forming the political advantages of policy-making by main leaders of the country attaching importance to CAM; implementing a diversified health care system policy for the goal of maximizing people＇s health interests; ensuring development of CAM by the coerciveness of law and the timeliness of policy adjustment; and promoting the protection and mining, sorting out and improving of CAM based on open and comprehensive policies.

TAKING THE PATH OF COMBINING TRADITIONAL CHINESE MEDICINE WITH WESTERN MEDICINE IN CANCER RESEARCH AND CONTROL

Chinese oncologists have made great progress on the prevention and treatment of tumor with the combined traditional Chinese medicine (TCM) and Western Medicine (WM). Combining TCM with WM features the cancer research and control in China and has obtained world attention. Researches on cancer prevention with TCM. According to the theories of TCM, cancer is the result of the long-term action of carcinogenic factors under the condition of "Internal Insufficiency" of the body. Some chronic inflammatory changes could cause epithelial cell proliferation and malignant changes. Consequently, TCM treatment for precancerous lesions is very important. The interrup tion effect of Liuwei Dihuang decoction (六味地汤) in severe epithelial atypical hyperplasia of

Research progress of integrated traditional Chinese and Western medicine in the treatment of advanced gastric cancer

Gastric cancer(GC)is a malignant tumor originating from the gastric epithelium,and its incidence and mortality rates rank third among all malignant tumors worldwide.It is also one of the most common cancers in China and is treated predominantly by Western medicine in clinical practice.However,with the advancements in medical technology and informatics,the values of traditional Chinese medicine(TCM)in preventing and treating GC and improving prognosis have increasingly been recognized.According to TCM,clinical manifestations of GC can be divided into Yege(dysphagia),regurgitation,stomach pain,and Zhengxia(abdominal mass).Due to the unbalanced distribution of health care resources in China,most GC patients already have progressive or advanced-stage disease at the first diagnosis.As a result,most GC patients have poor physical function,and surgery or chemotherapy alone will aggravate the impairment to the immune function and seriously affect the quality of life.In contrast,TCM therapies have shown promising efficacy in the management of these patients.Here we review the role of the integrated TCM and Western medicine in treating advanced GC.

Effects of COVID-19 fear and anxiety on attitudes towards complementary and alternative medicine use in women with gynecological cancer during the COVID-19 pandemic

Objective:Patients with gynecological cancer commonly use complementary and alternative medicine(CAM)methods to cope with the disease.However,despite the existence of treatment strategies,the effect of fear and anxiety caused by coronavirus disease 2019(COVID-19)pandemic on attitudes about CAM use is unclear.This study was carried out to investigate the effect of fear and anxiety experienced by patients with gynecological cancer during the COVID-19 pandemic on their attitudes towards the use of CAM.Methods:This is a cross-sectional and descriptive study that included 177 women with gynecological cancer;participants were recruited from a social networking site for cancer patients in Turkey between June and December 2021.Data were collected using an online survey that included the Personal Information Form,the Fear of COVID-19 Scale,the Coronavirus Anxiety Scale,and the Attitude Towards Holistic Complementary and Alternative Medicine Scale.Descriptive statistics,t-test,Pearson’s correlation test,and simple linear and multiple regression analyses were performed to analyze the data.Results:During the pandemic,55.4%of the participants reported using CAM methods,but only 22.6%were using CAM before the pandemic.The participants who used CAM during the pandemic also scored higher on the fear of COVID-19 and coronavirus anxiety scales(20.69±5.37 and 13.09±6.29,respectively)compared to the participants who did not use CAM(9.29±2.72 and 6.35±2.06,respectively).Fear of COVID-19 accounted for 52%of the CAM attitude score,while coronavirus anxiety accounted for 15%of the CAM attitude score.Fear of COVID-19 and coronavirus anxiety together accounted for 53%of CAM attitude.Conclusion:Gynecological cancer patients with high levels of COVID-19-related anxiety and fear during the pandemic used CAM more.Given that the psychological effects of the pandemic will continue in the coming years,CAM use should be evaluated as a coping strategy,especially due to the COVID-19-related anxiety and fear experienced by patients with gynecological cancer.While the rational and effective CAM methods should be supported,strategies should be developed to prevent misuse of CAM and its interference in prescribed medical treatments.

Acute moderate to severe ulcerative colitis treated by traditional Chinese medicine:A case report

BACKGROUND Ulcerative colitis(UC),also known as chronic nonspecific UC,is an inflammatory bowel disease characterized by diffuse colonic mucosal inflammation.The incidence and prevalence of UC have risen markedly,and the disease seriously affects the quality of life of patients and imposes a great burden on the world health care infrastructure and economy.CASE SUMMARY Case I describes a 34-year-old female who came to see a doctor because of repeated abdominal pain,diarrhoea and purulent blood for 2 mo.This patient had UC with an initial onset,an active stage and a wide range of lesions.After the poor effect of sulfasalazine and mesalazine,the patient’s condition gradually deteriorated,her abdominal pain and bloody stools continued,and anemia occurred.She began treatment with the Chinese medicine Guizhi Dahuang decoction,which was taken orally twice a day,200 mL each time.After 6 mo of treatment,abdominal pain,diarrhoea,bloody stool and other symptoms disappeared.No abnormality was found by repeat electronic enteroscopye,and the anemia was corrected.The patient’s condition did not recur after nearly 4 years of follow-up.CONCLUSION A series of symptoms in this UC patient significantly improved with the administration of traditional Chinese medicine.

Cancer Complementary and Alternative Medicine Research at the US National Cancer Institute

The United States National Cancer Institute （NCI） supports complementary and alternative medicine （CAM） research which includes different methods and practices （such as nutrition therapies） and other medical systems （such as Chinese medicine）. In recent years, NCI has spent around $120 million each year on various CAM-related research projects on cancer prevention, treatment, symptom/side effect management and epidemiology. The categories of CAM research involved include nutritional therapeutics, pharmacological and biological treatments, mind-body interventions, manipulative and body based methods, alternative medical systems, exercise therapies, spiritual therapies and energy therapies on a range of types of cancer. The NCI Office of Cancer Complementary and Alternative Medicine （OCCAM） supports various intramural and extramural cancer CAM research projects. Examples of these cancer CAM projects are presented and discussed. In addition, OCCAM also supports international research projects.

A Survey of Application of Complementary and Alternative Medicine in Chinese Patients with Parkinson’s Disease: A Pilot Study

Objective:To investigate the prevale nee and spectrum of complementary and alternative medicine(CAM)application and its related-factors in Parkinson's disease(PD)patients in China.Methods:A structured questionnaire regarding the use of CAMs was administered to PD patients by face-to-face interview.Demographic and social variables,clinical characteristics and treatments,and the related factors of PD were also surveyed.Results:Ninety out of 113 patients(79.6%)reported that they had received CAMs treatment,of which 48.6%(55/113)patients had received CAMs treatment for PD.The top 3 kinds of CAMs for PD were Chinese materia medica,rehabilitation exercise,and acupuncture ordinally.The source of information regarding CAMs treatment mainly came from relatives and friends(51.8%,73 cases),followed by physicians(31.9%,45 cases),and medias such as television,newspapers or the internet(16.3%,28 cases).Fifty percent of CAM users reported a good therapeutic efficacy,whereas 39% patients reported that they felt neither better nor worse after the treatment,while 11% patients claimed worsening of symptoms.Multiple correspondence analyses survey found the main factors affecting the selectivity of CAMs ranked in the following order:in come,education,occupati on,habitati on,age at on set,Hoeh n and Yahr staging,PD durati on,and gen der.Conclusion:CAMs,especially Chin ese materia medica,rehabilitation exercise,and acupuncture,are widely used for PD patients in China.

Primary Research on Chinese Medicine Treatment of Androgen-Independent Prostate Cancer

Prostate cancer(PC) is a common malignant tumor in the male seniors,and its incidence has been ascending in China in recent years. Over 80%of the patients are diagnosed as being in the late stage and lose the opportunity of radical operation because of its early stage metastasis. Endocrinotherapy is regarded

Progress in clinical research on the integration of Chinese and Western medicines for treating primary liver cancer

Primary liver cancer(PLC) is one of the most common malignant tumors in China. PLC is characterized by insidious onset, rapid progress, poor quality of life, and short survival time. Notably, current treatment strategies remain unsatisfactory. Traditional Chinese medicines(TCM) have been used to treat a variety of diseases, including liver diseases, for more than 2000 years. In this study, we performed a review of the use frequency and clinical efficacy of TCM in treating PLC. Relevant literature from January 1, 2009, to January 1, 2021 was retrieved from network databases of China National Knowledge Infrastructure(CNKI), Chongqing VIP, Wanfang, PubMed, and SinoMed. The most frequently used TCM and their efficacy in PLC treatment were summarized. Based on the inclusion and exclusion criteria, 33 articles were selected. Overall, the efficacy of the combination of TCM and Western medicines in the treatment of PLC was higher than that in the control groups(i.e. treatment with Western medicines alone)(65.11% vs.44.31%, P <.05). Among the 33 selected articles, 11 were investigated for TCM preparation(marketed drugs) and 22 for TCM formulas. In total, 102 types of TCM(single herbs) were used to treat PLC. The top five most frequently used TCM were Poria(14.71%), Astragali radix(13.73%), Atractylodis Macrocephalae Rhizoma(12.75%), Bupleuri radix(12.75%), and Glycyrrhizae radix et Rhizoma(11.76%). Of the 102 types of TCM, tonics were the most frequently used categories, followed by heat-clearing medicines, blood-invigorating medicines, and stasis-resolving medicines. Of 207 papers, 174(84.06%) could not be subjected to statistical analysis due to research quality. Further high-quality research on herb sources, formula components and dosage, toxicology, and ethics of TCM is necessary. In conclusion, TCM play a promising role in the treatment and management of PLC, although further investigations are warranted.

Review on Efficacy and Health Services Research Studies of Complementary and Alternative Medicine in Inflammatory Bowel Disease

Objective：To assess the evidence of the use and efficacy for complementary and alternative medicine（CAM） in inflammatory bowel disease（IBD）. Methods：A systematic literature search in MEDLINE was performed for randomized controlled trials（RCTs） in Crohn＇s disease and ulcerative colitis.Moreover,a selective literature search for health services research studies on the use of CAM in patients with IBD was performed.Results：Health services research studies showed a high use of CAM in adult and pediatric patients with IBD worldwide.In contrast to the high use among IBD patients,there was a lack of high-quality data for many of the used CAM methods.Although most of the studies showed positive results,the methodological quality of most studies was rather low;therefore,the results had to be interpreted with caution.While there were many studies for probiotics and fish oil,RCTs for the highly used method homeopathy, for most herbal products,and for traditional Chinese medicine methods apart from acupuncture RCTs were completely lacking.Conclusions：The lack of high-quality studies might be the consequence of the problems associated with the funding of clinical trials involving CAM.However,having the high user rates in mind,high-quality studies assessing efficacy and safety of those methods are urgently needed.Furthermore,there is a need for better representation of CAM in undergraduate and postgraduate medical education.

The relationship between anxiety about prostate cancer among patients with biochemical cancer recurrence and the use of complementary and alternative medicines,diet,and exercise

Objective:We aimed to explore associations between anxiety and specific health behaviors such as complementary and alternative medicine(CAM),diet,and exercise among prostate cancer patients.Methods:PCa patients enrolled in a prospective cohort study of men with biochemical cancer recurrence were surveyed about use of CAM,diet,and exercise.Anxiety was measured with the Memorial Anxiety Scale for Prostate Cancer(MAX-PC)and the anxiety subscale of the Hospital Anxiety and Depression Scale.Results:Nearly 70%(44 of 67)of the original cohort of patients completed the supplementary CAM survey.The mean age was 68 years.Eighty percent of respondents reported engaging in a rel-evant health behavior,and 64%reported doing so in direct response to their PCa diagnosis.Overall,the most prevalent specific behaviors were exercising(56%),making dietary changes(50%),taking calcium supplements(41%),and taking vitamin D supplements(39%).Elevated baseline PCa-specific anxiety(MAX-PC score>16)after biochemical cancer recurrence was associated with use of any CAM(P=0.01),use of herbs/supplements(P=0.01),and dietary changes(P=0.04).Conclusion:PCa patients commonly use CAM,dietary changes,and exercise in response to their diagnosis,and these changes are associated with elevated general and PCa-specific anxiety.

Research methods in complementary and alternative medicine： an integrative review

The scientific literature presents a modest amount ot evidence m the use or complementary ana al[erna- tire medicine （CAM）. On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important, Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.

Traditional Chinese medicine is a useful and promising alternative strategy for treatment of Sjogren’s syndrome:A review

Primary Sjogren’s syndrome(p SS)is a chronic autoimmune disease involving exocrine glands.Current studies have found that the occurrence of the disease is closely related to genetic,environmental and neuroendocrine factors,as well as abnormal activation of T and B lymphocytes.The etiology and pathogenesis of p SS is complex,and there is a lack of specific targeted drugs.Traditional Chinese medicines(TCMs)have been comprehensively investigated for their treatment effects on p SS.Through a systematic review of the literature,we summarized the TCMs used to treat p SS,and find that there are four major ways that TCMs are used,including upregulation of aquaporin proteins,suppression of cell apoptosis,suppression of the abnormal activation of B lymphocytes and suppression of the abnormal activation of T lymphocytes(balancing T helper type[Th]1/Th 2& Th17/Treg and suppressing follicular helper T[Tfh]cells).However,there are not enough data about the active constituents,quality control,pharmacokinetics,toxicity and modern preparations of these TCMs;therefore,more investigations are needed.This paper highlights the importance of TCMs for treating p SS and provides guidance for future investigations.

Promoting whole person health:Exploring the role of traditional Chinese medicine in Polish healthcare

Poland has a unique history of traditional Chinese medicine(TCM)dating back to the 17th century when Polish missionary Michael(Michal)Boym was a pioneer in the field.In the 20th century,his successor,Professor Zbigniew Garnuszewski,reintroduced acupuncture to medical practice in Poland.However,other methods of TCM and its holistic approach to patient care have not found their place in modern medicine in Poland.At present,the legal status of TCM in Poland remains unregulated,with TCM included in the broad spectrum of complementary and alternative medicine(CAM)practices.Few reports are available on the use of TCM methods among the Polish population.Integrative medicine combines conventional medicine with evidence-based CAM interventions and considers all aspects of a patient's health,including physical,emotional,mental,social,and environmental factors.An integrative healthcare model that incorporates TCM modalities and lifestyle recommendations as well as a whole person approach may provide a more sustainable solution for the constantly underfinanced Polish healthcare system,which faces challenges of multimorbidity in an aging society and limited access to care.The coronavirus disease 2019 pandemic,war in Ukraine,and ongoing climate crisis have underscored the need to strengthen the resilience of the Polish healthcare system and search for new solutions.A model of care that blends the best of biomedicine and TCM healing approaches may be a better option for both patients and the healthcare system in Poland.